Medical Options


Round 3-15There can often be a medical reason for recurrent miscarriage. We explore some of the treatments available.

Medically speaking, after you have experienced 3 miscarriages in a row, you qualify for testing to see if there is a reason why. For some women, the testing may show that there is no identifiable medical reason for the losses, in which case it was either ‘just bad luck’ or perhaps something that wasn’t able to be picked up via testing.

 

Here is a summary of the different tests that are available:

Hysteroscopy

A first line of treatment can be to undergo Hysteroscopy, a procedure whereby the doctor inserts a small telescope into the uterus via the cervix. In this way, it can potentially diagnose or even repair problems with the uterus that may predispose a woman to recurrent miscarriages. Some of these include: Uterine Septum, Fibroids, Polyps or Abnormal scarring.

 

Natural Killer Cells Testing

Our bodies are generally very effective in detecting foreign bodies such as infection or disease, kicking our immune response into gear and attacking these threatening cells. Pregnancy is a unique situation whereby the implanting embryo is by all accounts, a ‘foreign body’, yet our immune system must inherently know not to try to fight or eliminate it.

In some cases, our bodies line of defence, aka Natural Killer Cells, attack the developing embryo, mistaking it as a potential threat to the well-being of the mother – hence causing miscarriage. It is estimated that 15-25% of women with recurrent miscarriage or repeated IVF failure, have abnormally high levels of these natural killer cells.

There are two types of NKCs, those located in the blood and those located in the uterus, therefore a blood test and a uterine biopsy should be done for an accurate result. Women who are found to have high levels of NKCs are usually prescribed immune suppressive therapy consisting of Clexane (blood thinner), Prednisolone (steroid) and in extreme cases, Intravenous Immunoglobulin (IVIG).

The good news is that one women are found to have high levels of NKCs, nearly all will go on to have successful pregnancies.

For more information on Natural Killer Cells, visit: http://www.ivf.com.au/fertility-treatment/advanced-science/natural-killer-cell-testing

 

Laparoscopy

A laparoscopy is keyhole surgery that is performed to help your specialist identify any potential issues with your fallopian tubes, uterus or ovaries such as endometriosis, fibroids or uterine abnormalities.

It is a fairly straightforward day surgery procedure performed under general anaesthetic whereby a laparoscope is inserted through a small incision in the abdomen. If any treatment is needed, eg removal of fibroids or endometriosis, this can also be performed at the same time.

 

Genetic Testing – IVF/PGD:

 The vast majority of embryos created either naturally or via IVF are chromosomally abnormal and will result in a first trimester miscarriage. There may also be a known genetic condition or a translocation that embryos need to be screened for. IVF with PGD is a technique that can be used to test embryos, prior to being transferred into the uterus, for any abnormalities or inherited genetic conditions.

There are two main types of PGD – advanced embryo selection (Array CGH) which screens all 24 chromosomes in an embryo, and Karyomapping which is used if you or your partner are known carriers of a single gene disorder.

For more information, see below:

http://www.ivf.com.au/fertility-treatment/genetic-testing-pgd

http://www.ivf.com.au/fertility-treatment/genetic-testing-pgd/karyomapping

 

Investigative Testing Panel for Recurrent Miscarriage:

After 3 or more miscarriages in a row, most women will either ask or be referred for investigative testing. Approximately 50% of the time a cause will be found from undertaking these tests, but for the other half, no diagnosis will be made.

There are generally three main lines of testing as per below:

First line:

Pelvic Ultrasound

Full Blood Count

Thyroid Stimulating Hormone

FSH, LH and Oestrogen

Anticardiolipin antibodies

Lupus anticoagulant

Fasting insulin, glucose, homocysteine

Activated protein C resistance

Female/Male karyotype

 

Second Line:

Hysterosalpingogram, sonohysterogram or hysteroscopy

Factor V Leiden, prothrombin gene mutation, protein C, protein S

Antithrombin III

Anti-Mullerian hormone (AMH)

Male karyotype deletion

Sperm DNA fragmentation

 

Third Line:

Peripheral blood natural killer cells

Uterine natural killer cells

Embryo quality (IVF)

 

Taken from:

http://drgavinsacks.com.au/wp-content/uploads/2013/12/RMmedicineToday.pdf

 

** Please note the above is not an exhaustive list of medical options available **